Network Management - Senior Analyst
CVS HealthSalary not specified
Full Time
Senior (5 to 8 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates should possess a Bachelor's or Master's degree in Healthcare Analytics, Statistics, Finance, Data Science, or a related field, coupled with over 3 years of experience in healthcare claims analysis, payer analytics, or reimbursement modeling. A strong understanding of Medicare and commercial payer reimbursement methodologies, medical and pharmacy claims data, provider fee schedules, and healthcare financial modeling is essential. Proficiency in SQL, Python, or R for data analysis is required, and familiarity with contract negotiations, network management, and provider relations is a plus.
Responsibilities
The Senior Data Analyst will analyze medical and pharmacy claims data to identify trends, cost drivers, and optimization opportunities, supporting contract negotiations and sales initiatives. They will develop financial models to assess payer performance and reimbursement strategies, evaluate the financial impact of alternative payment models, and build reports and dashboards using SQL, Python, Power BI, or Tableau. The role involves collaborating with sales and contracting teams, working with Medicare, Medicaid, and commercial claims data, and ensuring data integrity for strategic decision-making.
Skills
Healthcare claims analysis
Payer analytics
Reimbursement models
Medicare reimbursement
SQL
Python
Power BI
Tableau
R
Financial modeling
Contract negotiations
Provider contracting
Fee schedules
Value-based care
Nomi Health
Direct access to affordable healthcare services
About Nomi Health
Nomi Health simplifies healthcare services by providing direct access to care in various communities across the United States. The company connects patients, healthcare providers, and businesses, reducing complexity and costs in the healthcare system. Nomi Health offers both in-person and virtual appointments, along with health clinics, in-home care, and care education services, making healthcare more accessible. Their real-time technology infrastructure modernizes healthcare delivery and provides analytics to turn data into actionable solutions. Nomi Health serves individual patients, healthcare providers, and businesses, helping the latter save up to 30% on healthcare costs by streamlining connections with providers. Additionally, the Nomi Health Charitable Foundation works to positively impact the communities they serve. Revenue is generated through direct healthcare services and a technology platform that simplifies payments and reimbursements.
Orem, UtahHeadquarters
2019Year Founded
$107MTotal Funding
SERIES_ACompany Stage
Social Impact, HealthcareIndustries
201-500Employees
Benefits
Unlimited PTO
Competitive salary
401k match
Medical, dental, & vision coverage
HSA
Career growth
Continuous learning
Family leave
Free counseling
Risks
Increased competition from companies like Aledade could challenge Nomi Health's market share.
Reliance on Medicaid populations poses risks if Medicaid funding or policy changes.
The partnership with CHG Healthcare may face execution challenges due to integration complexity.
Differentiation
Nomi Health offers both in-person and virtual healthcare appointments for convenience.
The company provides real-time technology infrastructure for modernized healthcare delivery.
Nomi Health's business model connects buyers, providers, and patients directly, reducing costs.
Upsides
Nomi Health's partnership with CHG Healthcare expands support to underserved communities.
The company's Success Care program shows high engagement rates in addiction recovery.
Nomi Health's Artemis Health subsidiary excels in benefits data and analytics solutions.
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